title: Geographic disparities in patient travel for dialysis in the United States.
abstract: OBJECTIVE
  To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients.
  
  
  METHODS
  Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 U.S. Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an "original" and "replacement" facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software.
  
  
  RESULTS
  The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs. 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs. 6.8 miles).
  
  
  CONCLUSIONS
  Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life.
authors.affiliation: Prima Health Analytics, Boston, Massachusetts.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Stephens
authors.forename: Samuel
authors.initials: S
authors.lastname: Brotherton
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Dunning
authors.forename: Larry C
authors.initials: LC
authors.lastname: Emerson
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.forename: David J
authors.initials: DJ
authors.lastname: Harrison
authors.forename: John J
authors.initials: JJ
authors.lastname: Kochevar
authors.forename: Ann C
authors.initials: AC
authors.lastname: McClellan
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.forename: Shaowei
authors.initials: S
authors.lastname: Wan
authors.forename: Matthew
authors.initials: M
authors.lastname: Gitlin
mesh_terms: D001334:Automobile Driving; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis; D012189:Retrospective Studies; D014195:Travel; D014481:United States / Q000453:epidemiology
keywords: access to care; dialysis; health disparities; rural; utilization of health services